Provider Demographics
NPI:1568086981
Name:VEGA, ZACHARY JUSTIN
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JUSTIN
Last Name:VEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8243 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1632
Mailing Address - Country:US
Mailing Address - Phone:787-243-1588
Mailing Address - Fax:
Practice Address - Street 1:8243 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1632
Practice Address - Country:US
Practice Address - Phone:787-243-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program